Domingo, Ernesto

Inequity in health care is the single most important health problem in many countries in the world. In the Philippines, where government health financing is weak, such inequity has been catastrophic in its effects. The nation’s poor are effectively deprived of access to quality and affordable health care, and suffer starkly higher mortality from preventable and treatable diseases. Building a public health system that includes and benefits all is an urgent national challenge.

ERNESTO DOMINGO, a seventy-six year-old physician, has dedicated his career to this challenge. A well-respected but unprepossessing specialist in hepatology and gastroenterology, DOMINGO has always valued the social side of his profession, devoting over four decades to the University of the Philippines-Manila (UPM) as researcher, teacher, chancellor, and university professor meritus. Passionate about science, he organized the UPM Liver Study Group and led in groundbreaking studies of viral hepatitis and liver disease which established the causative connection between chronic hepatitis-B and liver cancer. By determining as well the preventive solution to liver cancer—the immunization of newborns against hepatitis-B within twenty-four hours from birth reduces the probability of acquiring hepatitis by 95 percent—his research has saved millions of people from the danger of life-threatening illness, and reduced health care costs. Deeply concerned about the poor’s access to health care, he has pushed for hepatitis vaccination to be mandatory and available to all. Working closely with legislators, he has also successfully lobbied for a law that ensures annual budgetary support for neonatal hepatitis immunization.

From groundbreaking scientific discovery, to policy advocacy, to securing implementation resources, he has painstakingly demonstrated how medical science can truly protect and promote the quality of life of everyone, especially the poor.

His public health advocacy extends to an even wider field. In 2008, DOMINGO and distinguished colleagues formed the Universal Health Care (UHC) Study Group, a group committed to advancing, through research and advocacy, the goal of universal health care in the Philippines. Based on intensive studies of the country’s health system, the group produced a Blueprint for Universal Health Care and then actively campaigned for its adoption when the current administration assumed power in 2010. As co-convenor of the group, DOMINGO was influential in crafting the government’s Kalusugang Pangkalahatan (Universal Health Care) Program. And he has gone on to head, without compensation, the newly-formed Research Reference Hub of the Department of Health, which manages all health-related researches and translates research results into policies and plans in the government’s health care program.

DOMINGO is heartened to see that with the government’s commitment to Kalusugang Pangkalahatan, the Department of Health’s budget has doubled in three short years, a greater focus on health equity issues has led to some 80 percent of the population now enrolled in the national health insurance program, and public health care delivery capacities are being upgraded.

“Medicine is basically a social science,” DOMINGO says. “When you deal with families and communities, it cannot be anything else.” His conviction that diseases and their treatment cannot be detached from existing social conditions has driven him to espouse visionary reforms in health education and human resources, calling for greater social content in medical education and a shift from a “doctor-centered” system by empowering nurses, midwives, and other health workers. With colleagues in the UHC Study Group, he declares: “Our goal is to make the dream of health care based on health needs—rather than the ability to pay—a reality for the Philippines within the near future.”

In electing ERNESTO DOMINGO to receive the 2013 Ramon Magsaysay Award, the board of trustees recognizes his exemplary embrace of the social mission of his medical science and profession, his steadfast leadership in pursuing “health for all” as a shared moral responsibility of all sectors, and his groundbreaking and successful advocacy for neonatal hepatitis vaccination, thereby saving millions of lives in the Philippines.

I had the privilege of meeting President Ramon Magsaysay in person and shaking his hand. That was in 1953, when I graduated from high school. He was our commencement speaker. As I vividly recall, he was a physically imposing man with a handshake to match.

His physical attribute was complemented by an equally formidable moral certitude, very much appreciated by his people. Such appreciation was copiously expressed by the tears they shed upon his untimely death.

It is a humbling experience to be offered an award established in his memory.

In my more than half a century of involvement in the fields of medical research, health profession education and training, academic administration and advocacy, the most formidable challenge I have had to contend with is bridging the chasm that isolates excellence from relevance. The divide between the two is accurately articulated by the comment of a colleague in the Department of Medicine, who said, and I quote, “The Department’s evolution has been characterized by a recurring confrontation between the ideals of excellence and relevance. The excellence we aim for is often measured in terms of academic achievements. However, the people’s need is our only yardstick for relevance. Thus, what may be academically excellent may be outright irrelevant, while what is relevant may not require excellence at all.”

What my co-workers and I have attempted to do is to bridge this chasm between excellence and relevance. Our strategy is to make available to advocacy the output of medical research, innovative and often radical health professional education and training, and health system study.

Our advocacy is focused on mitigating inequity in health. We are voluntarily helping the Department of Health in its effort to implement the Aquino health agenda, Kalusugang Pangkalahatan, or Universal Health Care. As a solution to inequities in health, Universal Health Care has proven its efficacy worldwide. We should not be an exception.

If these efforts merit your award, then I accept it, without for a moment forgetting, that many colleagues and my family, too, have generously contributed to this enterprise.